One question we are asked consistently by people inquiring about our services is “Does Medicare Insurance pay for custodial (private duty) home care services”? Custodial in-home care is also referred to as “private duty” home care.

Custodial Care or Private Duty Home Care is non-medical care that helps individuals with his or her activities of daily living, preparation of special diets and self-administration of medication not requiring constant attention of medical personnel. Providers of custodial care are not required to undergo medical training. Therefore, ‘custodial care’ or ‘private duty’ home care, the care that provides the ‘activities of daily living’ and enables seniors to ‘age-in-place’ (usually their home) is often referred to as “non-medical” care.

It occurred to me that I have not created a blog post focused on the role of Medicare as it pertains to private-duty home care for seniors. So, with a few necessary definitions provided along the way, here goes.

First, let’s understand that Medicare insurance is a complex subject. Medicare was established by the federal government because at the time, most private insurers would not sell health insurance policies to older adults. From Wikipedia, “Medicare is a national social insurance program, administered by the U.S. federal government since 1965, currently using about 30 private insurance companies across the United States. Medicare was established by the federal government to care for a very vulnerable part of our population. However, private insurance companies execute the health insurance program.

Medicare guarantees access to health insurance for Americans aged 65 and older who have worked and paid into the system, and younger people with disabilities as well as people with end stage renal disease (Medicare.gov, 2012) and persons with amyotrophic lateral sclerosis. As a social insurance program, Medicare spreads the financial risk associated with illness across society, even to people who cannot use it and may never want it or use it, and thus has a somewhat different social role from private insurance, which involves a risk portfolio (underwriting) and adjusts premiums according to perceived risk.”

Today Medicare covers more than 50 million people, including most people 65 and older and approximately 8 million younger adults with disabilities. Medicare is not free, nor does it cover everything! Medicare is similar to group insurance or individual health insurance in that it generally pays for acute care and skilled care, not custodial care with two notable exceptions.

The notable exceptions are two limited and very specific conditions:

Medicare Part A pays for custodial care when it is part of hospice care, and

Medicare pays for custodial care in care settings such as home health care, but only if the beneficiary also receives skilled services and meets other criteria such as having a physician’s order for the services and using services provided only by Medicare-approved agencies. Medicare stops paying for custodial care when the patient no longer needs skilled care.

For clarity the following definitions are also important.

Acute Care is a pattern of health care in which a patient is treated for a brief but severe episode of illness, for the sequel of an accident or other trauma, or during recovery from surgery. Acute care is usually given in a hospital by specialized personnel using complex and sophisticated technical equipment and materials, and it may involve intensive or emergency care. This pattern of care is often necessary for only a short time, unlike chronic care.

Skilled Care is a type of intermediate care in which the patient or resident needs more assistance than usual, generally from licensed nursing personnel and certified nursing assistants.

So with the above listed limited exceptions, Medicare DOES NOT pay for custodial (private duty) in-home care unless the senior first needs skilled (medical) care.

What Does Medicare Cover Relative to In-Home Care?

Medicare Part A covers home health care services that include skilled nursing care, physical therapy, occupational therapy, speech therapy, and certain other health care services that patients receive in their homes for the treatment of or recovery from an illness or injury. In these cases, cases associated with these types of skilled care needs, Medicare covers non-medical or custodial (private duty) care needs. Medicare stops paying for custodial care when the patient no longer needs skilled care. Further, Medicare does not pay for long-term stays in nursing homes.

So that’s as clear as I can state the facts regarding Medicare and what it covers relative to private duty home care. I hope it helps. Should you have other questions regarding Medicare and private duty home care, feel free to contact me at kjohnson@visitingangels.com.

Although we provide home care to primarily older adults, we have been of service to other adults over the years. I thought I’d take a moment and give you some ideas that you too might consider as your needs and circumstances arise. Consider 5 unique scenarios and ways in which non-traditional clients have used our services.

JOINT REPLACEMENT. Joint replacement needs can strike at any age, from hip or knee replacements, to torn rotator cuffs. We can help during those first few days or weeks of recovery with bathing and dressing, meal prep and running errands.

ELECTIVE SURGERY. Most men or women who elect to undergo elective surgery desire to do so very discreetly. While close friends and family can provide much needed moral support, they perhaps are not as comfortable providing hands-on help. Let us help during this sensitive process while maintaining your privacy.

WEDDINGS & SPECIAL EVENTS. Mom is coming in town for your daughter’s wedding. Mom doesn’t have the stamina to dance the night away at the reception. A Visiting Angel caregiver would be a wonderful option to keep your mom company in her hotel room.

CHRONIC ILLNESSES. Many adults suffer from chronic and debilitating conditions such as MS and Parkinson’s. Visiting Angels can help provide a break for the spouse or adult child who provides care. Taking a break once a week for a haircut or to have dinner with a friend can be very energizing for the family caregiver.

HOSPICE ASSISTANCE. You have arranged for dad to receive hospice services but you realize they cannot stay long hours with him. You want someone with dad at all times during these last days just to sit quietly and make sure he is comfortable, and to alert hospice if needed Our compassionate, experienced caregivers can be a wonderful support.

With over 12 years of experience in providing home care, we have provided services in conjunction with each of the five scenarios listed above. If you have a home care need that may transition the traditional need associated with older adults, give us a call and let us help.

We wish you and your family peace and happiness throughout the holiday season. The safety and well-being of our loved-ones is always a concern for all of us – regardless of what time of year! However, if you have a senior loved one that is alone over the holiday’s, consider having us spend time with them. Depression is a serious issue for older adults and we can help with companion care and related services. If we can be of assistance in answering questions or providing caregiving services, please don’t hesitate to contact us via the web link on the right panel of this page, or give our office a call at 216.231.6400.

I do hope that 2014 has been a great year for you. As for Visiting Angels, 2014 has been another good year of helping older adults age-in-place with as much independence and grace as possible. We are thankful for the opportunity to serve and help so many older adults with their activities of daily living and providing them with companionship especially at this time of the year. We wish each and every one of our readers a wonderful and prosperous 2015.

The re-emergence of the Ebola virus has caused a global health care concern. As of this writing cases here, in the United States, have caused us to re-examine our overall preparedness with a ‘real-time’ health emergency. It is no surprise that rumors and inaccurate information is running rampant.

Our recommendation for accurate and up to date information, is the United States Centers for Disease Control (CDC). Click on this link, http://www.cdc.gov/vhf/ebola/index.html, to learn more about the disease and what you need to know about Ebola.

So what do we do? The CDC has developed quite an extensive checklist for healthcare providers titled, Health Care Provider Preparedness Checklist for Ebola Virus Disease. Although the information is geared mostly to the hospital setting, there is a lot of valuable information that can be used in the homecare setting as well. Under the additional resources section is a link to the Public Health Emergency site where you can register for webinars on the subject and subscribe to stay informed. The CDC checklist can be accessed via the following link: http://www.cdc.gov/vhf/ebola/pdf/healthcare-provider-checklist-for-ebola.pdf and the Public Health site via http://www.phe.gov.

If you have employee related questions or are unsure how to handle a specific employee situation, such as: an employee returning from travel abroad, questions about their return to work, or more questions of this nature, consult your attorney. He or she can guide you on appropriate H.R. policy for your state.

On Thursday, September 18th, our Visiting Angels’ office is proud to co-sponsor a Health Care Forum sponsored by Crain’s Cleveland Business. The forum will take place in downtown Cleveland at the new Cleveland Convention Center from 7:00AM to 1:00PM. Preceded by networking and breakfast, the morning will begin at 7:30AM with a morning keynote address.

Not only is our Visiting Angels office a conference sponsor, we are also participating in a breakout panel titled “Your employees, their eldercare concerns, your bottom line: What’s it costing you?” Our panel will be moderated by Crain’s Cleveland Business Publisher John Campanelli. I encourage you to attend and participate in this 90-minute panel that begins at 8:45AM. An overview of the panels issues we will be discussed; the panel participants are below.

PANEL #1 – “Your employees, their eldercare concerns, your bottom line: What’s it costing you?”
• Eldercare costs U.S. Businesses more than $33 Billion each year in lost productivity
• How can you calculate your company’s risk?
• What resources are available to help your employees handle their caregiving duties?
• How can businesses build support systems for employees who have significant caregiving duties?

Eldercare and the Workplace is an important topic. So much so, that our Visiting Angels office works with Caring Concierge, an independent company that specializes in the employer aspect of eldercare and how it impacts business. As a Certified Senior Advisor, I provide content and subject matter awareness to Visiting Angels’ Cleveland office and to Caring Concierge.

The morning’s content ends with a keynote presentation featuring some of northeast Ohio’s national leaders in health care. An overview of the closing keynote presentation and the panel participants are below:

We hope you will be able to attend this informative event. We look forward to speaking with you. For all of the information regarding the forum, please access the following hypertext link, Crain’s Health Care Forum.

Note: At no cost to employers, Caring Concierge provides bundled proven solutions to employee caregiving challenges that otherwise result in significant lost-time hours on the job.

In practically every field, every market, every facet of life, we use classifications as a tool for comparing, contrasting, and overall differentiation. This classification process also applies to gerontology or aging. We tend to ‘classify’ seniors in three categories:

Young-Old Ages 65 to 74

Old-Old Ages 75 to 84

Oldest-Old Ages 85 and older

There are broad characteristics of each of these age related demographics. As seniors age, their susceptibility to falls increase, and generally speaking, the severity of the outcome increases considerably. Fractures, particularly broken hips, can quickly lead to significantly diminished independence. Very often a fall can lead to a significantly shortened remaining life. That said, I never tire of talking about the serious nature of falls for seniors. Our oldest-old are the most susceptible but so much depends on the general health of the individual.

Ohio is home to more than 2.3 million seniors who want and deserve the chance to continue to grow, thrive and contribute to their communities,” said Bonnie K. Burman, Sc.D, director of the Ohio Department of Aging. “Falls and fall-related injuries pose a threat to independence and vitality, and while the risk of falls increases with age, falls are not a normal part of aging, and most can be prevented.”

Decreased muscle mass, vision and hearing decline, medical conditions and joint pain are some of the age-related changes that can increase falls risks. However, minor changes to the three H’s – home, health and habits – can offset these risk factors:
• Home: Remove throw rugs; improve lighting, especially near stairs; install grab bars in the bathroom; rearrange the home to make frequently used items easier to reach.

• Health: Ask your doctor about a falls risk assessment and talk about medicines you take and whether they increase your risk for falls; have your hearing and vision checked annually.

• Habits: Stay active to build muscle strength and improve balance; slow down and think through tasks; stay hydrated and eat a well-balanced diet that includes calcium-rich foods.

Most of all, learn to not be afraid of falling. A fear of falling can cause you to make decisions and changes in your behavior that actually increase your risk.STEADY U Ohio is the state’s comprehensive falls prevention initiative led by the Ohio Department of Aging and supported by Ohio government and state business partners. STEADY U partners are working to strengthen existing falls prevention activities, identify new opportunities and raise awareness of falls prevention strategies and resources. Visit www.steadyu.ohio.gov to take a falls risk self-assessment, find easy steps to prevent falls, and learn about A Matter of Balance, a free, community-based education program to help participants see falls as something they can control. “A Matter of Balance” classes are offered at Fairhill Partners, the non-profit organization where I serve as Board Chair. I recently referred a colleague’s mother to this program and I know that she will learn a great deal that will result in maintaining her independence for as long as possible. By taking steps to stay safe today, you can ensure that you remain healthy and independent tomorrow.